- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,409.04 / $8,539.35
| Facility | | $100.00 | $1,409.04 | $8,539.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.77 / $858.77 / $858.77
| Facility | | $858.77 | $858.77 | $858.77 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $526.61 / $526.61 / $526.61
| Facility | 62 | $526.61 | $526.61 | $526.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.26 / $84.26 / $84.26
| Facility | AS | $84.26 | $84.26 | $84.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |